Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy

John B. Malcolm, Aditya Bagrodia, Ithaar H. Derweesh, Reza Mehrazin, Christopher J. DiBlasio, Robert Wake, Jim Wan, Anthony Patterson

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephronsparing surgery (NSS). Patients and Methods: We retrospectively reviewed 749 patients (mean age 57.7 years; mean follow-up 6.4 years) who had RN or NSS for renal tumours between July 1987 and June 2006 at our institution. The demographics and outcomes were analysed and recorded. The primary outcome variable was the development of an estimated glomerular filtration rate (eGFR) of <?60 mL/min/1.73 m2 , with secondary outcomes being the development of a serum creatinine level of ≥?2.0 mg/dL, MA (serum bicarbonate < 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. Results: Of the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7% vs 16.0%, P < 0.001), MA (12.8% vs 7.2%, P = 0.02), proteinuria (22.2% vs 13.2%, P = 0.003) and elevated creatinine (14.2% vs 8.4%, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. Conclusions: Patients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. copyright

Original languageEnglish (US)
Pages (from-to)476-481
Number of pages6
JournalBJU International
Volume104
Issue number4
DOIs
StatePublished - Aug 2009

Fingerprint

Acidosis
Nephrectomy
Chronic Renal Insufficiency
Proteinuria
Glomerular Filtration Rate
Creatinine
Diabetes Mellitus
Smoking
Hypertension
Body Mass Index
Demography
Bicarbonates
Serum
Research Design
Logistic Models
Odds Ratio
Kidney
Incidence

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy. / Malcolm, John B.; Bagrodia, Aditya; Derweesh, Ithaar H.; Mehrazin, Reza; DiBlasio, Christopher J.; Wake, Robert; Wan, Jim; Patterson, Anthony.

In: BJU International, Vol. 104, No. 4, 08.2009, p. 476-481.

Research output: Contribution to journalArticle

Malcolm, John B. ; Bagrodia, Aditya ; Derweesh, Ithaar H. ; Mehrazin, Reza ; DiBlasio, Christopher J. ; Wake, Robert ; Wan, Jim ; Patterson, Anthony. / Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy. In: BJU International. 2009 ; Vol. 104, No. 4. pp. 476-481.
@article{5c8ef219c88d4c95883b80a574c134e3,
title = "Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy",
abstract = "Objective: To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephronsparing surgery (NSS). Patients and Methods: We retrospectively reviewed 749 patients (mean age 57.7 years; mean follow-up 6.4 years) who had RN or NSS for renal tumours between July 1987 and June 2006 at our institution. The demographics and outcomes were analysed and recorded. The primary outcome variable was the development of an estimated glomerular filtration rate (eGFR) of <?60 mL/min/1.73 m2 , with secondary outcomes being the development of a serum creatinine level of ≥?2.0 mg/dL, MA (serum bicarbonate < 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. Results: Of the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7{\%} vs 16.0{\%}, P < 0.001), MA (12.8{\%} vs 7.2{\%}, P = 0.02), proteinuria (22.2{\%} vs 13.2{\%}, P = 0.003) and elevated creatinine (14.2{\%} vs 8.4{\%}, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. Conclusions: Patients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. copyright",
author = "Malcolm, {John B.} and Aditya Bagrodia and Derweesh, {Ithaar H.} and Reza Mehrazin and DiBlasio, {Christopher J.} and Robert Wake and Jim Wan and Anthony Patterson",
year = "2009",
month = "8",
doi = "10.1111/j.1464-410X.2009.08376.x",
language = "English (US)",
volume = "104",
pages = "476--481",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy

AU - Malcolm, John B.

AU - Bagrodia, Aditya

AU - Derweesh, Ithaar H.

AU - Mehrazin, Reza

AU - DiBlasio, Christopher J.

AU - Wake, Robert

AU - Wan, Jim

AU - Patterson, Anthony

PY - 2009/8

Y1 - 2009/8

N2 - Objective: To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephronsparing surgery (NSS). Patients and Methods: We retrospectively reviewed 749 patients (mean age 57.7 years; mean follow-up 6.4 years) who had RN or NSS for renal tumours between July 1987 and June 2006 at our institution. The demographics and outcomes were analysed and recorded. The primary outcome variable was the development of an estimated glomerular filtration rate (eGFR) of <?60 mL/min/1.73 m2 , with secondary outcomes being the development of a serum creatinine level of ≥?2.0 mg/dL, MA (serum bicarbonate < 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. Results: Of the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7% vs 16.0%, P < 0.001), MA (12.8% vs 7.2%, P = 0.02), proteinuria (22.2% vs 13.2%, P = 0.003) and elevated creatinine (14.2% vs 8.4%, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. Conclusions: Patients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. copyright

AB - Objective: To investigate the incidence of and risk factors for developing chronic renal insufficiency (CRI), proteinuria and metabolic acidosis (MA) in patients treated with radical nephrectomy (RN) or nephronsparing surgery (NSS). Patients and Methods: We retrospectively reviewed 749 patients (mean age 57.7 years; mean follow-up 6.4 years) who had RN or NSS for renal tumours between July 1987 and June 2006 at our institution. The demographics and outcomes were analysed and recorded. The primary outcome variable was the development of an estimated glomerular filtration rate (eGFR) of <?60 mL/min/1.73 m2 , with secondary outcomes being the development of a serum creatinine level of ≥?2.0 mg/dL, MA (serum bicarbonate < 22 mmol/L), and proteinuria ( ≥ 1 + on dipstick testing). Multivariate logistic regression (MV) was used to identify risk factors for developing an eGFR of < 60 mL/ min/1.73 m 2 , a creatinine level of ≥ 2.0 mg/dL and MA. Results: Of the 749 patients, 499 had RN and 250 NSS; there were no significant demographic differences between the groups. After surgery a significantly greater proportion of the RN than the NSS group had a low eGFR (44.7% vs 16.0%, P < 0.001), MA (12.8% vs 7.2%, P = 0.02), proteinuria (22.2% vs 13.2%, P = 0.003) and elevated creatinine (14.2% vs 8.4%, P = 0.022). MV showed that diabetes mellitus (odds ratio 8.96, P = 0.002), RN (5.32, P < 0.001), hypertension (4.55, P = 0.003), a body mass index (BMI) of ≥ 30 kg/m 2 (3.51, P = 0.017), age ≥ 60 years (2.91, P = 0.015) and smoking (2.44, P = 0.014) were risk factors for developing a low eGFR; and that age ≥ 60 years (2.00, P = 0.019), diabetes mellitus (10, P < 0.001), hypertension (7.41, P = 0.002), smoking (5.29, P < 0.001) and RN (3.08, P < 0.001) were risk factors for developing an elevated creatinine level; and that being male (2.50, P = 0.019), age ≥ 60 years (3.13, P = 0.002), a BMI ≥ 30 (3.52, P < 0.001), RN (9.82, P < 0.001), preoperative eGFR < 60 (9.71, P < 0.001) and elevated creatinine (5.9, P = 0.008) were risk factors for developing MA. Conclusions: Patients undergoing RN had significantly greater CRI, MA and proteinuria rates than a well-matched group undergoing NSS. In addition to RN, age ≥ 60 years, diabetes mellitus, hypertension and smoking were associated with progression to CRI after surgery. copyright

UR - http://www.scopus.com/inward/record.url?scp=69849100841&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=69849100841&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2009.08376.x

DO - 10.1111/j.1464-410X.2009.08376.x

M3 - Article

VL - 104

SP - 476

EP - 481

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 4

ER -